胃憩室的临床及影像诊断分析.docxVIP

胃憩室的临床及影像诊断分析 李雪莱(沈阳市第五人民医院影像科 M0024) 【中图分类号】R445 [文献标识码】A【文章编号]1672-5085 (2012) 18-0010-03 【摘要】目的探讨胃憩室的影像学表现。资料与方法回顾性分析经纤维胃内窥 镜和手术病理证实的□例胃憩室的临床和影像特征。结果□例单发憩室中， 位于贲门下后壁者9例，1例位于胃窦大弯侧伴发胃窦小弯侧溃疡。1例发牛在 胃小弯侧伴有小弯侧溃疡。1例贲门憩室患者同时发现胃食管反流征象。1例贲 门憩室同时伴左肾上腺憩室。胃憩室的特征性影像表现为单发囊袋状突出影，多 伴有明显狭颈，内有黏膜伸入。憩室大小形态可变具有收缩性等。结论尽管存 在局限性，顿餐造影是诊断胃憩室的可靠有效手段。 【关键词】胃憩室 低张胃肠顿餐检查 计算机体层摄影 纤维胃内窥镜 Clinico-radiologic Analysis of gastric diverticulum [Abstract] Objective To investigate the imagingmAnifestation of gastric diverticulum.Methods and Meterials: The clinical data andX?ray imaging features of 11 cases of gastric diverticulums con firmed by fiber gastroscopy and surgery and pathology were retrospectively analyzed.Results: Among the 11 cases of single diverticulum,nine cases were located in inferoposterior to cardia,0ne case in the antral large curvature accompanied by the lesser curvature ulcer;。ne case in the lesser curvature of the stomach with the lesser curvature ulcer.One case of cardia diverticulum was also found gastroesophageal reflux signs.Left adrenal gland diverticulum was shown on one case of cardia diverticulum.The features of image of the gastric diverticulummAnifested as single pouch-like shadow,which normally accompanied by significantly narrow neck and gastric mucosa can extend to the pouch.Diverticulum is variable in size and has a contraction function.Conclusion Gastric barium meal is a reliable and effective means of diagnosis of gastric diverticulum,though has limitations. 【Key words］ gastric Diverticulum Hypotonic gastrointestinal barium meal Computed Tomography Fiber gastroscopy 胃憩室为罕见性疾病，在消化道憩室中发病率最低［1］。由于该病缺乏典 型的临床症状，故常将其误诊为其他消化系统疾病。笔者冋顾性研究了我院 2005-2011年间经纤维胃镜及手术病理证实的11例胃憩室患者的临床及影像资 料，旨在分析其临床及影像特征并探讨漏诊及误诊原因。 临床资料 一、 性别及年龄：口例患者中，男性7例，女性4例。年龄21岁?75 岁，平均48岁。 二、 临床表现：11例中有3例无症状，于健康体检和其他疾病的检查 中发现。6例均有上腹部及剑突下钝痛，以餐后12小时内明显。1例诉有反酸 及剑突下烧灼感，于饭后和平卧时加重，1例伴黑便及贫血。 三、 纤维胃镜检查：大都表现为脐样凹陷的憩室开口，并可见自然开张 和闭合的动态变化。憩室口部呈向心性隆起，由正常无侵润粘膜覆盖，同时见粘 膜皱叢伸入囊内［如图1］。1例由于同吋并发胃体小弯侧溃疡，憩室口为增粗的 粘膜所掩盖未被发现而漏诊。 四、 手